TL;DR - if you or someone you love has ADD/ADHD and you are trying to figure out how to help, SKIP THIS BOOK AT ALL COSTS. It is detrimental in all senses advocating expensive snake oil and other more potentially abusive solutions.
Dr. Daniel Amen is the most popular Psychiatrist in the world. He specializes in brain disorders and not shy of the spotlight. He has built a billion dollar industry on his claims and methodology and published many books on the subject. So, this is where I started when I wanted to re-explore my relationship with ADD as an adult.
I found Amen's comprehensive work to be be well organized, easy to follow, provocative, and full of helpful tidbits. However, I also found it overly-prescriptive, dismissive, extremely dated, and full of dubious or unsubstantiated claims. While I appreciate his qualitative approach to treatment, it is also confusing then that he then presents this ad hoc qualitative approach as quantitative without any substantial or validated research behind it.
According to Amen, his extensive use of SPECT scanning gives him the unique ability to understand ADD/ADHD in a way no one else can. He presents his outlines and basic findings for his definitions of (now) 7 distinct types of ADD based on these SPECT brain scans. These are: Classic, Inattentive, Overfocused, Temporal Lobe, Limbic, Ring of Fire, and Anxious along with the bonus type of Head Trauma. Each type may be characterized by a symptom, treatment, or scan similarities. Symptoms range widely and may include: inattentive, distractable, hyperactive, impulsive, dishonest, manipulative, short attention span, poor organizational skills, procrastination, daydreaming, hyper-focus, perfectionism, anger, aggression, violent tendencies, paranoia, sensory issues (i.e. touch or light), "nasty behavior", unpredictability, anxiety, fearfulness, fearlessness, tense, headaches, stomachaches, anxiety attacks, and inappropriate sexual behavior.
"Holy crap. That's a really broad base of symptoms. I mean... I resonate with some of those but others seem contradictory or really extreme. Is all this ADD?"
I'm right there with you. And this is where things started to fall apart for me. The problems begins when we start to ask, "what are we really calling ADD?" With the great breadth of definition in the above, one could diagnose just about anything you wanted under this broad spectrum. And modern psychology has started to examine ADD under the broader spectrum of sensory disorders as a result though the Amen clinics do not recognize this. The above resonates too strongly with the tendency in the 80s and 90s to conveniently blame all child difficulties on ADD/ADHD.
"But the brain scans are proof of his diagnostic trends!"
I'm glad you brought that up. Lets talk about SPECT for a moment. SPECT stands for Single Photon Emission Computed Tomography. Information from SPECT is gathered based on the spatial concentration of injected radioactive pharmaceutical compounds. Very similar to PET scanning. Very different to an MRI.
There is zero reliable evidence that establishes SPECT as an accurate way to assess or diagnose anything about the human condition. Amen would disagree, but he has an empire to defend.
Some notes on SPECT. -what is it-why not PET or CAT
So why SPECT? It is what was available early in his career. And it is extremely cheap (like 1/20th the cost of maintaining a CAT or PET lab) to operate. This is the most profitable way to show someone any kind of correlative brain patterns or activity.
There are serious ethical questions to be raised here. His SPECT studies operate only on an out-of-pocket basis which puts him 1) beyond the reach of regulatory agencies. He is 'self-taught' in his methodologies (which again, were out of pocket for his subjects) which sounds a lot like 2) unregulated experimentation at a patient's expense. And finally, 3) there is not an insignificant risk to the exposure of radiation required - especially for young children. If the risk-factors are similar to PET, this would mean approximately 18 cancer deaths as a result of his 70,000 scans. And all, unapologetically, being done for profit.
Were treatment is concerned, I liked Amen's approach which began with a huge focus on lifestyle and holistic choices (i.e. diet and exercise) before medication. I think he struck a very good balance here and I think this portion of the book could easily be pulled out on its own. However, if you pull that out, its just good advice and not specific to ADD at all. Everyone should eat well. Everyone should exercise. This is obviously where the origins of Daniel Plan stem.
As a clinician, this is where I think Amen's work falls apart. Amen writes like a behaviorist of the 1980s with complete reliance on A+B=C causal relationships. Ironincally, peer-reviewed research in brain-scanning has led to a resurgence in the other end of the spectrum over the last several decades. Amen ignores more modern resarch.
More troubling, Amen very dismissive of the people in his book with ADD. It was clear he struggled greatly in his relationships with those he loved. And he presents those around persons with ADD as the real victims. But he is empowering in in his dismissive attitude of persons with ADD - defining them as quarrelsome and manipulative and talking about how they need to be 'handled'. There was no humanization of what it was like to be a person with ADD. For Amen, 'healing' means functioning in the world and no longer being a problem or embarrassment for those around you. This is the kind of sentiment that sees a spike in abuse among children with mental disabilities.
In conclusion, Dr. Amen has some great anecdotal advice about communication, conflict, and diet. However, taken into context with ADD was specifically problematic. And this is where I have decided to leave it. At best, Amen has some great life advice and his methods may reach some people that are otherwise unreachable. At worst, Amen proffers his magic snake oil with complete disregard for the greater medical community. Either way, not for me.